What medicines cannot mix with Lexapro?

October 9, 2025 •

3 min read

Lexapro (escitalopram) is prescribed to millions of adults for depression and anxiety, but taking the wrong combination of drugs can lead to life-threatening complications. To ensure your safety, it is crucial to understand what medicines cannot mix with Lexapro and how to prevent dangerous drug interactions.

Quick Summary

This guide details the medications that must not be taken with Lexapro, including MAOIs and other serotonergic drugs that can cause serotonin syndrome. It also covers combinations with blood thinners and NSAIDs that increase bleeding risks, and discusses substances like alcohol that can exacerbate side effects.

Key Points

Avoid MAOIs: The combination of Lexapro and MAOIs is strictly forbidden and can cause a life-threatening serotonin syndrome.
Be Cautious with Serotonergic Drugs: Other antidepressants, triptans, and opioids can also dangerously increase serotonin levels when mixed with Lexapro.
Mind the Bleeding Risk: Combining Lexapro with blood thinners, aspirin, or NSAIDs significantly elevates the risk of abnormal bleeding.
Stay Away from St. John's Wort: This herbal supplement is a serotonin booster and can trigger serotonin syndrome in combination with Lexapro.
Limit or Avoid Alcohol: Alcohol can intensify Lexapro's side effects like drowsiness and counteract its therapeutic effects.
Disclose Everything to Your Doctor: Always inform your healthcare provider about all medications, supplements, and substances to prevent harmful drug interactions.

Understanding Lexapro's Mechanism

Lexapro is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin levels in the brain by blocking reabsorption. This action helps improve mood and reduce anxiety. However, combining Lexapro with other substances that affect serotonin or the central nervous system can cause severe reactions.

The Absolute Contraindications: Medications to Avoid

Some medications should never be combined with Lexapro due to a high risk of life-threatening side effects. If you are taking any of these, your doctor will guide you on a safe transition.

Monoamine Oxidase Inhibitors (MAOIs)

Taking MAOIs with Lexapro dramatically increases the risk of serotonin syndrome, a potentially fatal condition caused by excessive serotonin. A minimum 14-day gap is required between stopping an MAOI and starting Lexapro, and vice versa.

Pimozide (Orap)

Pimozide should not be mixed with Lexapro as it can cause QT prolongation, a serious heart rhythm issue.

Serious Interactions Increasing Serotonin Levels

Combining Lexapro with other substances that increase serotonin can lead to serotonin syndrome. This includes triptans, other antidepressants (SSRIs, SNRIs, TCAs), and some opioid pain medications. Lithium and Buspirone also affect serotonin and require caution.

Herbal and Illicit Substances

St. John's Wort significantly increases the risk of serotonin syndrome with Lexapro. Illicit drugs such as ecstasy, cocaine, and LSD can also dangerously elevate serotonin levels.

Interactions Affecting Bleeding Risk

Lexapro can increase the risk of bleeding or bruising. This risk is higher when combined with medications that interfere with blood clotting.

Anticoagulants and Antiplatelet Drugs

Close monitoring is needed when combining Lexapro with blood thinners like Warfarin, newer oral anticoagulants (e.g., apixaban, rivaroxaban), and antiplatelet agents (e.g., clopidogrel).

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs like ibuprofen, naproxen, and aspirin increase the risk of gastrointestinal bleeding with Lexapro. Acetaminophen is a safer alternative.

Alcohol and Sedating Agents

Alcohol

Avoiding alcohol while on Lexapro is strongly recommended. While not found to potentiate cognitive effects in a clinical trial, the combination can increase drowsiness and dizziness. Alcohol can also worsen depression and anxiety symptoms.

Benzodiazepines and Other Sedatives

Combining Lexapro with sedatives or anti-anxiety medications like benzodiazepines can intensify drowsiness and sedation.

Comparison Table: Common Lexapro Interactions


Drug Type	Examples	Primary Risk	Action
Monoamine Oxidase Inhibitors (MAOIs)	Phenelzine, Selegiline, Linezolid	Serotonin Syndrome (Severe)	Avoid entirely. Requires a 14-day washout period.
Pimozide (Antipsychotic)	Orap	QT Prolongation (Heart Rhythm)	Avoid entirely. Can be fatal.
Triptans (Migraines)	Sumatriptan, Rizatriptan	Serotonin Syndrome	Monitor carefully. High alert for serotonin syndrome.
Blood Thinners	Warfarin, Apixaban, Aspirin	Increased Bleeding Risk	Use with caution and monitor closely, especially if long-term.
NSAIDs (Pain/Inflammation)	Ibuprofen, Naproxen	Increased Bleeding Risk	Consult doctor before use. Acetaminophen is a safer alternative.
Other Antidepressants	Zoloft, Effexor, Cymbalta	Serotonin Syndrome	Avoid combination. Only adjust dose under strict medical supervision.
St. John's Wort	Herbal Supplement	Serotonin Syndrome	Avoid entirely. Can dangerously raise serotonin levels.
Alcohol	Any Alcoholic Beverage	Increased Side Effects, Worsened Depression	Avoid. Can interfere with medication efficacy and safety.

What is Serotonin Syndrome?

Serotonin syndrome is a life-threatening condition from excessive serotonin levels, often due to drug interactions or dosage changes. The full symptoms of Serotonin syndrome are outlined on {Link: Drugs.com https://www.drugs.com/pro/lexapro.html}.

Seek immediate medical attention if you experience symptoms of serotonin syndrome.

Conclusion

Understanding potential drug interactions with Lexapro is crucial to avoid severe outcomes. Caution is also needed with other serotonergic agents, blood thinners, NSAIDs, alcohol, and St. John's Wort. Always provide your healthcare provider with a complete list of all medications and supplements. Open communication with your doctor or pharmacist is key to safe medication use. To learn more about drug interactions, you can visit the {Link: FDA website https://www.fda.gov/drugs/drug-safety-and-availability/drug-interactions-what-you-should-know}.

Frequently Asked Questions

It is generally not recommended to take NSAIDs like ibuprofen, naproxen, or aspirin with Lexapro, as the combination significantly increases the risk of abnormal bleeding. Acetaminophen (Tylenol) is often a safer alternative for pain relief, but you should always consult your doctor before combining medications.

Serotonin syndrome is a serious condition caused by an overabundance of serotonin in the brain, often triggered by drug interactions. Symptoms include agitation, confusion, rapid heart rate, high blood pressure, muscle rigidity, tremors, and excessive sweating. Seek immediate medical attention if you suspect serotonin syndrome.

No, it is not recommended to drink alcohol while taking Lexapro. Alcohol is a depressant and can worsen anxiety and depression symptoms, making the medication less effective. It can also amplify side effects such as drowsiness, dizziness, and impaired coordination.

Yes, the herbal supplement St. John's Wort is a known serotonin booster and should not be combined with Lexapro. The combination dramatically increases the risk of developing serotonin syndrome.

Combining Lexapro with other serotonergic antidepressants, including other SSRIs, SNRIs, or TCAs, is not recommended without close medical supervision. This is because it can cause a dangerous overload of serotonin, leading to serotonin syndrome.

If you realize you have taken a medication that interacts with Lexapro, do not panic, but do not take another dose of the interacting medication. Call your doctor or a pharmacist immediately for guidance. If you experience symptoms of serotonin syndrome, such as agitation, high heart rate, or fever, seek emergency medical attention.

When switching between an MAOI and Lexapro, there must be a 'washout' period of at least 14 days where you do not take either medication. This allows your body's serotonin levels to return to a safe baseline before starting the new drug.